Background, Rationale and Suggested Implementation Strategies
- Educate providers about the elimination of HCAP and new broader CAP definition per the 2019 IDSA/ATS CAP guidelines.
- Educate providers on the justification for 5 days of therapy for uncomplicated CAP.
- Review CAP cases identified by HMS to implement high-yield interventions for recurrent problems
- Evaluate and understand differences in provider groups (e.g., Hospitalists, Emergency Medicine providers). Target interventions to specific provider groups as necessary.
- Evaluate existing order sets to ensure antibiotic preferred options, doses, and durations are consistent with institutional pneumonia guidelines.
- Require documentation of dose and indication of antibiotics prescribed in the antibiotic order.
- Encourage documentation of dose, indication, and duration of antibiotics in the progress note.
- Require a 72-hour Antibiotic Time Out, during which total duration should be discussed.
- Focus efforts on discharge prescribing, as HMS data shows that discharge prescriptions account for 80% of inappropriate antibiotic treatment for uncomplicated CAP.
- Require documentation of the total duration of antibiotics in the discharge summary, potentially incorporating an area for antibiotic duration to be filled out in an automated discharge process.
- Incorporate nursing and pharmacy into review of the discharge antibiotic.
- Provide audit and feedback directly to providers regarding the duration of antibiotics they use for patients with uncomplicated CAP.
- Consider incorporating compliance with treatment duration for uncomplicated CAP as part of hospitalists’ performance targets (for compensation).
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